Positive correlation between erythrocyte levels of n-3 polyunsaturated fatty acids and bone mass in postmenopausal Korean women with osteoporosis

Perilla seed oil improves bone health by inhibiting bone resorption in healthy Japanese adults: A 12-month, randomized, double-blind, placebo-controlled trial

Accumulating evidence suggests the beneficial effect of omega-3 polyunsaturated fatty acids (PUFAs) on bone mineral density (BMD). However, the effects of perilla (Perilla frutescens) seed oil (PO), a rich source of α-linoleic acid (LNA), on human bone have not yet been elucidated. This randomized, double-blind, placebo-controlled trial investigated the effects of long-term PO intake on bone health in Japanese adults. After screening for eligibility, 52 participants (mean age 54.2 ± 6.4 years) were randomly assigned to placebo (n = 25) and PO (n = 27) groups, which received 7.0 ml of olive oil and PO daily, respectively. At baseline and 12-month, quantitative ultrasound of the right calcaneus was measured with an ultrasound bone densitometer and percentage of the Young Adult Mean (%YAM) was calculated. Serum levels of tartrate-resistant acid phosphatase 5b (TRACP-5b), and bone alkaline phosphatase (BALP) were evaluated. In addition, PUFA levels in the erythrocyte plasma membrane (RBC-PM), serum biological antioxidant potential (BAP), and diacron reactive oxygen metabolites (d-ROM) were evaluated. Compared with the placebo group, %YAM levels increased and serum TRACP-5b levels decreased significantly in the PO group at 12-month, while serum BALP levels remained unchanged. Moreover, RBC-PM LNA levels and BAP/d-ROM ratios increased significantly in the PO compared with the placebo group. These results suggest that long-term PO intake may improve age-related BMD decline by suppressing bone resorption and increasing LNA levels.

Decreased Serum Maresin 1 Concentration Is Associated With Postmenopausal Osteoporosis: A Cross-Sectional Study

Background: Maresin 1 plays a role in the regulation of inflammation and metabolic diseases in vivo. An increasing number of studies have reported that postmenopausal osteoporosis (PMOP) is associated with inflammation. However, the potential relationship between the serum Maresin 1 content and PMOP is unclear.

Aims: 1) To evaluate the Maresin 1 content in postmenopausal women with osteopenia, osteoporosis, or without these conditions (normal group) and 2) to analyze the correlations between Maresin 1 concentrations and bone mineral density (BMD) and bone turnover markers.

Methods: In this cross-sectional study, we measured serum Maresin 1 concentrations, serum biochemical parameters, markers of bone metabolism, and BMD of the femoral neck, lumbar spine, and hip in 141 postmenopausal women.

Results: We found that serum Maresin 1 in the osteopenia (140.09 ± 30.54 pg/ml) and PMOP (124.68 ± 31.35 pg/ml) groups were significantly lower than those in the normal group (167.38 ± 24.85 pg/ml) (P < 0.05 and P < 0.001). Serum Maresin 1 levels were positively correlated with femoral neck, lumbar spine, and hip BMD (P < 0.001). Meanwhile, Maresin 1 concentrations were positively associated with 25-hydroxyvitamin D [25(OH)D] levels (P < 0.001), but negatively correlated with β-CrossLaps of type 1 collagen containing cross-linked C-telopeptide (β-CTX) (P = 0.002), procollagen type I amino-terminal propeptide (PINP) (P = 0.004), tartrate-resistant acid phosphatase 5b (TRAP-5b) (P = 0.005), and osteocalcin (OC) levels (P = 0.001). Multivariate logistic regression analysis showed that a decrease in Maresin 1 concentration was still associated with osteopenia (P = 0.035) or PMOP (P = 0.016). Maresin 1 levels had a maximum area under curve of 0.820 for osteopenia and 0.746 for PMOP (P < 0.001). Our results showed that the serum Maresin 1 levels were reduced in osteopenia and PMOP patients compared with that in normal subjects, and were the lowest in the PMOP subjects. The results suggest that Maresin 1 may serve as a new non-invasive diagnostic biomarker for PMOP.

Effect of n-3 polyunsaturated fatty acid on bone health: A systematic review and meta-analysis of randomized controlled trials

Bone metabolism is a complicated process, which involves bone modeling and remodeling. If this process is unbalanced, bone loss and resultant osteoporosis might occur. Recently, nutrition supplementations such as n-3 polyunsaturated fatty acids (PUFAs) are considered to be used on improving the bone metabolism and reducing the risk of osteoporosis. To more precisely assess the effects of n-3 PUFA supplementation on bone mass and clarify its potential mechanism, we have conducted a systematic review and meta-analysis. Based on the strict inclusion and exclusion criteria, 12 articles were included in this meta-analysis. The results in articles show that n-3 PUFAs could slightly enhance the level of bone mineral density (BMD) (0.005 g/cm2; 95% CI, 0.000-0.010) (n = 7), which was the primary outcome for the research in comparison with the control group. In addition, the results also illustrate that the increasing effect on BMD (0.024 g/cm2; 95% CI, 0.020-0.028) became more significant for postmenopausal women. N-3 PUFAs had no significance on the level of bone-specific alkaline phosphatase (BALP) (-0.24 µg/L; 95% CI, -0.86 to 0.39) and osteocalcin (-0.63 μg/L; 95% CI, -1.84 to 0.57) (n = 5), which are the specific markers of bone formation. When compared with the eicosapentaenoic acid + docosahexaenoic acid supplementation, the supplementation form of α-linolenic acid significantly increased the content of BALP (0.396 µg/L; 95% CI, 0.069-0.724). The effects of n-3 PUFAs on bone resorption biomarkers containing type I collagen cross-linked C-terminal peptide (CTX) and type I collagen cross-linked N-terminal peptide (NTX) are considered and used in our study. Results indicated that participants who received n-3 PUFAs significantly decreased the level of CTX in the human body (-0.367 μg/L; 95% CI, -0.726 to -0.007) (n = 4). However, there was no significant difference in NTX levels in humans after supplementation with n-3 PUFA (-1.744 µg/L; 95% CI, -3.970-0.481) (n = 3). For postmenopausal women, it presented a significant decreasing level of CTX (-0.393 µg/L; 95% CI, -0.651 to -0.135) and NTX (-2.082 µg/L; 95% CI, -2.970 to -1.195) within their bodies. In conclusion, these findings suggested that n-3 PUFAs might have a beneficial effect on bone health, especially for α-linolenic acid supplementation form or for postmenopausal women.

N-3 PUFA ameliorated bone loss induced by postmenopausal depression following exposure to chronic mild stress and maternal separation by regulating neuronal processes

Depression induced by chronic mild stress (CMS) reduced bone mass in ovariectomized (OVX) rats, and maternal separation (MS) during early life aggravated depression-induced bone mass destruction. N-3 polyunsaturated fatty acids (PUFA) have been shown to improve bone mass and depression, but the bone-protecting effects of n-3 PUFA were unclear in CMS+MS-induced depression models. The purpose of this study was to determine whether n-3 PUFA improved CMS+MS-induced postmenopausal bone loss via its antidepressant-like action. Rats were fed diets containing 0% of total energy intake (en %) of n-3 PUFA during lifetime or 1 en % n-3 PUFA during pre-weaning or post-weaning periods, or their entire lifetimes and were allocated to CMS or CMS+MS groups after OVX. Lifetime supply of n-3 PUFA enhanced bone mass and microarchitecture, and expression of runt-related transcription factor 2, while decreasing blood levels of amino-terminal cross-linked telopeptide of type 1 collagen and the expression of receptor activator of nuclear factor kappa Β ligand/osteoprotegerin, activating transcription factor 4, and adrenergic receptor β2. Lifetime supply of n-3 PUFA decreased levels of adrenocorticotropic hormone and corticosterone and the expression of corticotropin-releasing factor in the brain but increased expression of the glucocorticoid receptor, serotonin-2C receptor, cAMP response element-binding protein (CREB), and calmodulin kinase IV and serotonin levels. Supply of n-3 PUFA during the pre-and post-weaning periods had beneficial effects on the brain but not on the bones. Lifetime supply of n-3 PUFA ameliorated bone loss induced by chronic stress by regulating hypothalamic-pituitary-adrenal axis activity and serotonin-CREB signaling.

Effect of Escherichia coli lipopolysaccharide challenge on eggshell, tibia, and keel bone attributes in ISA brown hens exposed to dietary n-3 fatty acids prior to onset of lay

The impact of Escherichia coli lipopolysaccharide (LPS) challenge on eggshell, tibia, and keel bone characteristics in ISA brown hens derived from breeders and pullets fed omega-3 polyunsaturated fatty acids (n-3 PUFA) was examined. The breeders were fed the following diets: 1) Control (CON); 2) CON + 1% microalgae as the source of docosahexaenoic acid (DHA); and 3) CON + 2.6% of a co-extruded mixture of full-fat flaxseed and pulses as a source of α-linolenic acid (ALA). During the pullet phase, offspring from breeders fed CON were fed CON or supplemented diets, and offspring from supplemented diets either continued with respective n-3 PUFA diets or CON. At 18 weeks of age (WOA), pullets were fed a common layer diet to 42 WOA. A total of 5 birds were selected based on the average body weight (BW) of each treatment and moved to an individual cage at 41 WOA. Three days before the end of 42 WOA, all the birds were weighed and subcutaneously injected with either saline or 4 mg LPS/kg BW. Eggs were recorded, labeled, and kept for egg quality analyses. At 42 WOA, birds were necropsied for tibia and keel bone samples. Administration of LPS reduced eggshell breaking strength, eggshell weight, tibia, and keel bone ash content (P < 0.05). Specifically, LPS challenged hens had 14.9, 11.1, 9.2, and 11.6% lower eggshell breaking strength, eggshell weight, keel, and tibia ash content, respectively relative to unchallenged hens. Hens from breeders and pullets fed n-3 PUFA had similar (P > 0.05) eggshell, tibia, and keel bone attributes to control hens. In conclusion, the provision of ALA and DHA to breeders and their offspring did not alleviate the negative effects of LPS on eggshell, tibia, and keel bone characteristics in laying hens.

Effects of DHA-Rich n-3 Fatty Acid Supplementation and/or Resistance Training on Body Composition and Cardiometabolic Biomarkers in Overweight and Obese Post-Menopausal Women

Resistance training (RT) and n-3 polyunsaturated fatty acids (n-3 PUFA) supplementation have emerged as strategies to improve muscle function in older adults. Overweight/obese postmenopausal women (55–70 years) were randomly allocated to one of four experimental groups, receiving placebo (olive oil) or docosahexaenoic acid (DHA)-rich n-3 PUFA supplementation alone or in combination with a supervised RT-program for 16 weeks. At baseline and at end of the trial, body composition, anthropometrical measures, blood pressure and serum glucose and lipid biomarkers were analyzed. Oral glucose tolerance tests (OGTT) and strength tests were also performed. All groups exhibit a similar moderate reduction in body weight and fat mass, but the RT-groups maintained bone mineral content, increased upper limbs lean mass, decreased lower limbs fat mass, and increased muscle strength and quality compared to untrained-groups. The RT-program also improved glucose tolerance (lowering the OGTT incremental area under the curve). The DHA-rich supplementation lowered diastolic blood pressure and circulating triglycerides and increased muscle quality in lower limbs. In conclusion, 16-week RT-program improved segmented body composition, bone mineral content, and glucose tolerance, while the DHA-rich supplement had beneficial effects on cardiovascular health markers in overweight/obese postmenopausal women. No synergistic effects were observed for DHA supplementation and RT-program combination.

Dietary interventions for better management of osteoporosis: An overview

Osteoporosis is a public health concern and a cause of bone loss, increased risk of skeletal fracture, and a heavy economic burden. It is common in postmenopausal women and the elderly and is impacted by dietary factors, lifestyle and some secondary factors. Although many drugs are available for the treatment of osteoporosis, these therapies are accompanied by subsequent side effects. Hence, dietary interventions are highly important to prevent osteoporosis. This review was aimed to provide a comprehensive understanding of the roles of dietary nutrients derived from natural foods and of common dietary patterns in the regulation of osteoporosis. Nutrients from daily diets, such as unsaturated fatty acids, proteins, minerals, peptides, phytoestrogens, and prebiotics, can regulate bone metabolism and reverse bone loss. Meanwhile, these nutrients generally existed in food groups and certain dietary patterns also play critical roles in skeletal health. Appropriate dietary interventions (nutrients and dietary patterns) could be primary and effective strategies to prevent and treat osteoporosis across the lifespan for the consumers and food enterprises.

Marine n-3 Polyunsaturated Fatty Acids and Bone Mineral Density in Kidney Transplant Recipients: A Randomized, Placebo-Controlled Trial

Kidney transplant recipients are at high risk of progressive bone loss and low-energy fractures in the years following transplantation. Marine n-3 polyunsaturated fatty acids (n-3 PUFA) supplementation may have beneficial effects on bone strength. The Omega-3 fatty acids in Renal Transplantation (ORENTRA) trial was an investigator initiated, randomized, placebo-controlled trial investigating the effects of marine n-3 PUFA supplementation after kidney transplantation. Effects of supplementation on bone mineral density (BMD) and calcium metabolism were pre-defined secondary endpoints. Adult kidney transplant recipients (n = 132) were randomized to 2.6 g marine n-3 PUFA supplement or olive oil (control) from 8 to 52 weeks post-transplant. Dual energy X-ray absorptiometry was performed to assess changes in bone mineral density of hip, spine, and forearm, as well as trabecular bone score (TBS) of the lumbar spine. Student's t test was used to assess between-group differences. There were no differences in ΔBMD between the two groups (intervention vs. control) at lumbar spine (-0.020 ± 0.08 vs. -0.007 ± 0.07 g/cm², p = 0.34), total hip (0.001 ± 0.03 vs. -0.005 ± 0.04, p = 0.38), or other skeletal sites in the intention-to-treat analyses. There was no difference in the change in TBS score (0.001 ± 0.096 vs. 0.009 ± 0.102, p = 0.62). Finally, no effect on biochemical parameters of mineral metabolism was seen. Results were similar when analyzed per protocol. In conclusion, we found no significant effect of 44 weeks of supplementation with 2.6 g of marine n-3 PUFA on BMD in kidney transplant recipients.

Plasma Fatty Acids and Quantitative Ultrasound, DXA and pQCT Derived Parameters in Postmenopausal Spanish Women

Different factors may contribute to the development of osteopenia or osteoporosis. Fatty acids are key nutrients for health, and a number of studies have reported an association between bone mineral density (BMD) and fatty acid intake. We aimed to investigate the relationships between serum levels of different fatty acids and bone parameters determined by quantitative bone ultrasound (QUS), peripheral quantitative computed tomography (pQCT), and dual-energy X-ray absorptiometry (DXA) in a sample of Spanish postmenopausal women. We enrolled a total of 301 postmenopausal women (median age 59 years; interquartile range (IQR) 7) in this study. All participants underwent full densitometric screening, including calcaneal quantitative ultrasound (QUS), peripheral quantitative computed tomography (pQCT), and dual-energy X-ray absorptiometry (DXA), as well as plasma fatty acid measurement. After adjustment for potential confounders, plasma n-3 polyunsaturated fatty acid (PUFA) levels correlated with BMD in the spine (r = 0.150; p = 0.014) and femoral neck (r = 0.143; p = 0.019). By multiple linear regression, an independent statistically significant positive relationship was observed between BMD in the spine and BMI (β = 0.288; p = 0.001) as well as total plasma n-3 PUFAs (β = 0.155; p = 0.009). The plasma n-3 PUFA level was also a significant and positive predictor of BMD at the femoral neck (β = 0.146; p = 0.009). Independent risk factors for low BMD (T-score ≤ 1) were determined by logistic regression analysis, and a relatively high level of plasma n-3 PUFAs (OR = 0.751; 95% CI 0.587-0.960, p = 0.022) was identified as a protective factor against low bone mass. In this single-center sample of Spanish postmenopausal women, we reported a significant positive and statistically independent association between BMD and plasma levels of n-3 PUFAs.

Do polyunsaturated fatty acids protect against bone loss in our aging and osteoporotic population?

Age-related bone loss is inevitable in both men and women and there will soon be more people of extreme old age than ever before. Osteoporosis is a common chronic disease and as the proportion of older people, rate of obesity and the length of life increases, a rise in age-related degenerating bone diseases, disability, and prolonged dependency is projected. Fragility fractures are one of the most severe complications associated with both primary and secondary osteoporosis and current treatment strategies target weight-bearing exercise and pharmacological intervention, both with limited long-term success. Obesity and osteoporosis are intimately interrelated, and diet is a variable that plays a significant role in bone regeneration and repair. The Western Diet is characterized by its unhealthy components, specifically excess amounts of saturated fat intake. This review examines the impact of saturated and polyunsaturated fatty acid consumption on chronic inflammation, osteogenesis, bone architecture, and strength and explores the hypothesis that dietary polyunsaturated fats have a beneficial effect on osteogenesis, reducing bone loss by decreasing chronic inflammation, and activating bone resorption through key cellular and molecular mechanisms in our aging population. We conclude that aging, obesity and a diet high in saturated fatty acids significantly impairs bone regeneration and repair and that consumption of ω-3 polyunsaturated fatty acids is associated with significantly increased bone regeneration, improved microarchitecture and structural strength. However, ω-6 polyunsaturated fatty acids were typically pro-inflammatory and have been associated with an increased fracture risk. This review suggests a potential role for ω-3 fatty acids as a non-pharmacological dietary method of reducing bone loss in our aging population. We also conclude that contemporary amendments to the formal nutritional recommendations made by the Food and Nutrition Board may be necessary such that our aging population is directly considered.

Omega-3 fatty acids in pathological calcification and bone health

Omega-3 fatty acids (ω-3FAs) such as Docosahexaenoic acid (DHA) and Eicosapentanoic acid (EPA), are active ingredient of fish oil, which have larger health benefits against various diseases including cardiovascular, neurodegenerative, cancers and bone diseases. Substantial studies documented a preventive role of omega-3 fatty acids in pathological calcification like vascular calcification and microcalcification in cancer tissues. In parallel, these fatty acids improve bone quality probably by preventing bone decay and augmenting bone mineralization. This study also addresses that the functions of ω-3FAs not only depend on tissue types, but also work through different molecular mechanisms for preventing pathological calcification in various tissues and improving bone health. PRACTICAL APPLICATIONS: Practical applications of the current study are to improve the knowledge about the supplementation of omega-3 fatty acids. This study infers that supplementation of omega-3 fatty acids aids in bone preservation in elder females at the risk of osteoporosis and also, on the contrary, omega-3 fatty acids interfere with pathological calcification of vascular cells and cancer cells. Omega-3 supplementation should be given to the cardiac patients because of its cardio protective role. In line with this, omega-3 supplementation should be included with chemotherapy for cancer patients as it can prevent osteoblastic potential of breast cancer patients, responsible for pathological mineralization, and blocks off target toxicities. Administration of omega-3 fatty acid with chemotherapy will not only improve survival of cancer patients, but also improve the bone quality. Thus, this study allows a better understanding on omega-3 fatty acids in combating pathological complications such as osteoporosis, vascular calcification, and breast microcalcification.

n-3 fatty acids fed to ISA brown and Shaver white breeders and their female progeny during rearing: Impact on egg production, eggshell, and select bone attributes from 18 to 42 weeks of age

The impact of feeding sources of n-3 fatty acids (FA) to ISA brown and Shaver white breeders and their female offspring during rearing on egg production, eggshell, tibia, and keel bone attributes was examined. Breeders were fed Control (CON) or CON + 1% dried microalgae (DMA: Aurantiochytrium limacinum) as the source of docosahexaenoic acid or CON + 2.6% of a coextruded mixture of full-fat flaxseed (FFF) and pulses as a source of α-linolenic acid. Day-old offspring were fed 1) breeder CON-pullet CON (CON-CON), 2) breeder CON-pullet DMA (CON-DMA), 3) breeder CON-pullet FFF (CON-FFF), 4) breeder DMA-pullet CON (DMA-CON), 5) breeder DMA-pullet DMA (DMA-DMA), 6) breeder FFF-pullet CON (FFF-CON), and 7) breeder FFF-pullet FFF (FFF-FFF). At 18 wk of age (WOA), pullets were fed a common layer diet to 42 WOA for egg production and bone quality assessments. There was no (P > 0.05) interaction between strains and diets and the main effect of diets on egg production, egg mass, and eggshell quality. There was an interaction (P = 0.008) between strain and diet on egg weight (EW); however, the strain effect on EW (P < 0.001) was such that ISA brown had heavier eggs than Shaver white. Shaver white had higher (P < 0.001) eggshell %, eggshell, and tibia breaking strength (BS), as well as tibia ash concentration compared with ISA brown hens. In contrast, ISA brown hens exhibited heavier (P < 0.05) tibia and keel bones. Feeding breeders DMA and pullets both sources of n-3 FA increased tibia medullary ash concentration compared with other diets (P < 0.001). Shaver white hens showed greater decline in tibia BS (83.7 vs. 96.3%) and ash content (84.1 vs. 94.3%) than ISA brown hens from 18 to 42 WOA (P < 0.05). Strain and diets exhibited independent effects on eggshell, tibia, and keel attributes. Provision of α-linolenic acid and docosahexaenoic acid to breeders and offspring improved tibia medullary ash concentration at 42 WOA.

Bone Benefits of Fish Oil Supplementation Depend on its EPA and DHA Content

The preventive effect of high-dose (9%) regular-fish oil (FO) against bone loss during aging has been demonstrated, but the effects of a low-dose (1%–4%) of a highly purified concentrated FO (CFO) has not been elucidated. The aim of this study was to determine the dose-dependent effect of a CFO against bone loss in C57BL/6 female mice during aging. Twelve-month old mice were fed with 1% and 4% CFO and 4% safflower oil (SFO) diets, including a group with a 4% regular-FO diet and a group with a lab chow diet for 12 months. Bone mineral density (BMD) was analyzed by dual-energy x-ray absorptiometry (DXA) before and after the dietary intervention. At the end of dietary intervention, bone resorption markers in serum and inflammatory markers in bone marrow and splenocytes and inflammatory signaling pathways in the bone marrow were analyzed. As compared to the 4% SFO control, 4% CFO maintained higher BMD during aging, while 1% CFO offered only a mild benefit. However, the 1% CFO fed group exhibited slightly better BMD than the 4% regular-FO fed group. BMD loss protection by CFO was accompanied by reduced levels of the bone resorption marker, TRAP, and the osteoclast-stimulating-factor, RANKL, without affecting the decoy-receptor of RANKL, osteoprotegerin (OPG). Further, CFO supplementation was associated with an increase in the production of IL-10, IL-12, and IFN-γ and a decrease in the production of TNF-α and IL-6, and the activation of NF-κB, p38 MAPK, and JNK signaling pathways. In conclusion, the supplementation of 4% CFO is very efficient in maintaining BMD during aging, whereas 1% CFO is only mildly beneficial. CFO supplementation starting at middle age may maintain better bone health during aging.

Dietary docosahexaenoic acid contributes to increased bone mineral accretion and strength in young female Sprague-Dawley rats

Growing evidence suggests that docosahexaenoic acid (DHA: 22:6n-3) enhances bone mineral content (BMC) and bone mineral density (BMD) in adulthood and during aging, however the effects during and after sexual maturation are unclear. The aim of this study was to examine the dose-response of BMC, BMD and microarchitectural properties of bone to dietary DHA in healthy growing female rats during acquisition of peak bone mass (PBM). Female Sprague-Dawley rats (n = 12/diet) were randomized to receive a control diet (AIN-93 M, 60 g soybean oil/kg diet) or an experimental diet containing 0.1, 0.4, 0.8 and 1.2% DHA (w/w of total diet) for 10 weeks. Dietary DHA increased the whole body, lumbar spine and long bone BMC compared to the control, in addition to higher aBMD and also BMD. Additionally, an increase in cortical bone microarchitecture parameters of lumbar spine as well as peak force were observed in dietary DHA diet groups. Dietary DHA contributes to PBM when consumed during and after sexual maturation, however higher doses of DHA do not provide further benefits.

Public health relevance of drug-nutrition interactions

The public health relevance of drug–nutrition interactions is currently highly undervalued and overlooked. This is particularly the case for elderly persons where multi-morbidity and consequently polypharmacy is very common. Vitamins and other micronutrients have central functions in metabolism, and their interactions with drugs may result in clinically relevant physiological impairments but possibly also in positive effects. On 12 April 2016, the University Medical Center Groningen (The Netherlands), as part of its Healthy Ageing program, organized a workshop on the public health relevance of drug–nutrient interactions. In this meeting, experts in the field presented results from recent studies on interactions between pharmaceuticals and nutrients, and discussed the role of nutrition for elderly, focusing on those persons receiving pharmaceutical treatment. This paper summarizes the proceedings of the symposium and provides an outlook for future research needs and public health measures. Since food, pharma and health are closely interconnected domains, awareness is needed in the medical community about the potential relevance of drug–nutrition interactions. Experts and stakeholders should advocate for the integration of drug–nutrition evaluations in the drug development process. Strategies for the individual patients should be developed, by installing drug review protocols, screening for malnutrition and integrating this topic into the general medical advice.

Osteoporosis in East Asia: Current issues in assessment and management

The greatest burden of hip fractures around the world is expected to occur in East Asia, especially China. However, there is a relative paucity of information on the epidemiology and burden of fractures in East Asia. Osteoporosis is greatly under-diagnosed and under-treated, even among the highest-risk subjects who have already suffered fractures. The accessibility to bone densitometry, the awareness of the disease by professionals and the public, and the use and reimbursement of drugs are some of the areas which need improvement especially. Cost-effective analysis on screening strategy and intervention thresholds based on local epidemiology data and economic status are available only in Japan. In addition, clinical risk factor models for the assessment of fracture probability may be ethnic specific. Further research is needed to develop a cost-effective risk assessment strategy to identify high-risk individuals for screening and treatment based on local data. Moreover, inadequate calcium and vitamin D intake is still an issue faced by this region.

The Association between the Consumption of Fish/Shellfish and the Risk of Osteoporosis in Men and Postmenopausal Women Aged 50 Years or Older

Fish rich in n-3 polyunsaturated fatty acids have been suggested to have a favorable effect on bone health, but previous epidemiologic studies have shown inconsistent results. The purpose of the present study was to investigate the hypothesis that the consumption of fish and shellfish is positively associated with bone mass and negatively associated with the risk of osteoporosis in Koreans and Americans. Men and postmenopausal women ≥50 years old from the Korean National Health and Nutrition Examination Survey 2008–2011 (n = 7154) and the National Health and Nutrition Examination Survey 2007–2010 (n = 2658) were included. There was a positive correlation between the consumption of fish and shellfish and bone mineral density (BMD) of the total femur, femoral neck, and lumbar spine in Koreans. Consistently, multivariate logistic regression analysis showed a significant association between intake of fish and shellfish and the risk of osteoporosis in Koreans but not in Americans. Consumption of fish and shellfish was 4–5 times higher in Koreans than Americans in the present study. In conclusion, intake of fish and shellfish was associated with BMD and the risk of osteoporosis in Koreans but not in Americans, suggesting that a minimum intake level of fish and shellfish might be recommended to protect against bone loss and osteoporosis.

Plasma n-3 Polyunsaturated Fatty Acids and Bone Mineral Density in Renal Transplant Recipients

OBJECTIVE

Renal transplant recipients (RTR) suffer high rates of bone loss and increased risk of fracture. Marine n-3 polyunsaturated fatty acids (n-3 PUFA), found mainly in fish and seafood, may have beneficial effects on bone and are positively associated with bone mineral density (BMD) in healthy elderly. The aim of this study was to investigate if this association prevails despite the more complex causes of bone loss in RTR.

DESIGN, SUBJECTS, AND METHODS

A total of 701 RTR were included in a cross-sectional analysis. BMD of lumbar spine, proximal femur, and distal forearm were measured by dual energy x-ray absorptiometry scan, and blood samples were drawn in the fasting state for measurement of plasma fatty acid composition 10 weeks posttransplant. Multiple linear regression analysis was used to assess the association between plasma marine n-3 PUFA levels and BMD.

RESULTS

Mean age was 52.2 years, and two-thirds were men. Based on femoral neck T-scores, 26% of patients were osteoporotic and 52% osteopenic. Z-scores increased significantly across quartiles of marine n-3 PUFA levels, and marine n-3 PUFA was a positive predictor of BMD at total hip and lumbar spine after multivariate adjustment. No association was found between n-6 PUFA content and BMD.

CONCLUSIONS

Plasma marine n-3 PUFA levels were positively associated with BMD at the hip and lumbar spine 10 weeks posttransplant.

GPR120: A bi-potential mediator to modulate the osteogenic and adipogenic differentiation of BMMSCs

Free fatty acids display diverse effects as signalling molecules through GPCRs in addition to their involvement in cellular metabolism. GPR120, a G protein-coupled receptor for long-chain unsaturated fatty acids, has been reported to mediate adipogenesis in lipid metabolism. However, whether GPR120 also mediates osteogenesis and regulates BMMSCs remain unclear. In this study, we showed that GPR120 targeted the bi-potential differentiation of BMMSCs in a ligand dose-dependent manner. High concentrations of TUG-891 (a highly selective agonist of GPR120) promoted osteogenesis via the Ras-ERK1/2 cascade, while low concentrations elevated P38 and increased adipogenesis. The fine molecular regulation of GPR120 was implemented by up-regulating different integrin subunits (α1, α2 and β1; α5 and β3). The administration of high doses of TUG-891 rescued oestrogen-deficient bone loss in vivo, further supporting an essential role of GPR120 in bone metabolism. Our findings, for the first time, showed that GPR120-mediated cellular signalling determines the bi-potential differentiation of BMMSCs in a dose-dependent manner. Additionally, the induction of different integrin subunits was involved in the cytoplasmic regulation of a seesaw-like balance between ERK and p38 phosphorylation. These findings provide new hope for developing novel remedies to treat osteoporosis by adjusting the GPR120-mediated differentiation balance of BMMSCs.

n-3 Polyunsaturated Fatty Acids and their Role in Cancer Chemoprevention

Polyunsaturated fatty acids (PUFAs), including omega-3 (n-3) and omega-6 (n-6) PUFAs, are essential for human health. Recent research shows n-3 PUFAs and their mediators can inhibit inflammation, angiogenesis and cancer via multiple mechanisms, including reduced release of n-6 fatty acid arachidonic acid from cell membranes, inhibition of enzymatic activities, and direct competition with arachidonic acid for enzymatic conversions. In this review, we discuss inflammation-related cancer, anti-inflammatory effects of n-3 PUFA lipid mediators, antineoplastic activities of n-3 PUFA in vitro and in vivo, and present an update on recent human trials.

Expression of ezrin in vagina cells of postmenopausal rats after dietary administration of omega-3 Fatty Acid formula

Objectives

To see the effect of dietary administration of omega 3-fatty acid formula on the vaginal cells of postmenopausal rats.

Methods

Three-week-old female Wistar/ST rats were raised after one week of adjustment period. The rats were then divided into three groups, for three different kinds of diet; general diet, 1% omega-3 fatty acid diet, and 2% omega-3 fatty acid diet. After eight weeks of having assigned diet, after the oophorectomy, with the same diet previously they had Immunohistochemistry, Immunofluorescence, and Western Blot about ezrin, merlin were done.

Results

In immunohistochemistry, estrogen injection group revealed thicker and well differentiated features. In Immunofluorescence, Omega-3 fatty acid composition in diet did not effect expression of ezrin and merlin in rat vagina in estrogen injection group, their vaginal epithelium showed full layers (from basal to apical layer). In Western Blot analysis, Omega-3 fatty acid composition in diet did not affect expression of ezrin and merlin in rat vagina estrogen presented significant impact on expression of ezrin and merlin.

Conclusion

Although omega-3 fatty acid composition changed in diet, vaginal epithelial morphology unchanged. Estrogen did effect on vagina cell, but omega-3 fatty acid did not effect on ezrin and merlin in vagina.

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Several studies have reported that the status in omega-3 polyunsaturated fatty acid (PUFA) and the omega-3/omega-6 PUFA ratio are positively related to bone health. This study aimed at examining the relationship between the status of different PUFAs and bone strength expressed by the stiffness index (SI) among indigenous women in northern Canada and Greenland, whose diets are rich in PUFAs compared to those of non-Aboriginals. Our study includes 118 Inuit women from Nuuk (Greenland), 195 Inuit women from Nunavik (Canada), and 249 Cree women of from East James Bay (Canada). Projects in Nunavik and in the Cree communities had a cross-sectional design and the Greenland project, a longitudinal design. The content of some PUFAs phospholipids of erythrocyte membranes was measured after transmethylation by gas chromatography coupled with a flame ionization detector. Stiffness index was measured by ultrasound at the right calcaneus with a water-bath Achilles Lunar instrument (Greenland) or an Achilles Insight instrument (Nunavik, East James Bay). Relations between SI and various PUFAs were studied using multiple linear regression analyses. Eicosapentaenoic acid (EPA) was positively and significantly associated with SI (log), even after adjustment for several confounders and covariates in all three projects. A high EPA status, resulting mainly from the consumption of fatty fish or marine mammal fat, seems to have a positive effect on bone strength measured by ultrasonography among Aboriginal women from three different populations.

Effects of arachidonic acid on the concentration of hydroxyeicosatetraenoic acids in culture media of mesenchymal stromal cells differentiating into adipocytes or osteoblasts

Metabolites derived from the polyunsaturated fatty acids (PUFA) may modulate the mesenchymal stromal cell (MSC) differentiation. Such cells can differentiate into different cellular types, including adipocytes and osteoblasts. Aging favors the bone marrow MSC differentiation toward the former, causing a loss of bone density associated with pathologies like osteoporosis. The omega-6 arachidonic acid (AA) favors MSC adipogenesis to a greater extent than omega-3 eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). In this work, we study the joint action of both PUFA. Thus, not induced and induced to adipocyte or osteoblast MSC were treated with 20 μM of each PUFA (either AA, AA + DHA or AA + EPA). The expression of osteogenic and adipogenic molecular markers, the alox15b lipoxygenase gene expression and the 5-, 8-, 11-, 12- and 15-hydroxyeicosatetraenoic acids (HETE) derived from the AA metabolism in the culture media were determined. The results show that the adipogenesis induction of AA is not suppressed by the joint presence of EPA and DHA. In fact, both increased the adipogenic effect of AA on MSC differentiated into osteoblasts. The different HETE concentrations increased in cultures supplemented with AA, albeit such concentrations were lower in the cultures induced to differentiate, mainly at day 21 after the induction. Furthermore, the reduction in the HETE concentration was correlated with a higher expression of the alox15b gene. These results highlight the PUFA metabolism differences between uninduced and induced MSC to differentiate into adipocytes and osteoblasts, besides the relevant role of the lipoxygenase gene expression in adipogenesis induction.

Compression fracture in postpartum osteoporosis

Osteoporosis is mainly a problem in postmenopausal women. However, we had a case of postpartum compression fracture associated with osteoporosis. A 42-year-old multiparous woman had undergone tertiary cesarean section without complications 1 month before. She was breast-feeding her baby and had no other bone-related complication history. She did not exercise on a regular basis. She experienced back pain abruptly and was diagnosed with a recent compression fracture of T12, L1, and L3. We evaluated this rare case of postpartum osteoporosis and compression fracture.

A new insight to bone turnover: role of ω-3 polyunsaturated fatty acids

Background. Evidence has shown that long-chain polyunsaturated fatty acids (LCPUFA), especially the ω-3 fatty acids such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are beneficial for bone health and turnover. Objectives. This review summarizes findings from both in vivo and in vitro studies and the effects of LC PUFA on bone metabolism, as well as the relationship with the oxidative stress, the inflammatory process, and obesity. Results. Some studies in humans indicate that LCPUFA can increase bone formation, affect peak bone mass in adolescents, and reduce bone loss. However, the cellular mechanisms of action of the LCPUFA are complex and involve modulation of fatty acid metabolites such as prostaglandins, resolvins and protectins, several signaling pathways, cytokines, and growth factors, although in certain aspects there is still some controversy. LCPUFA affect receptor activator of nuclear factor κβ (RANK), a receptor found on the osteoclast, causing bone resorption, which controls osteoclast formation. Conclusions. Since fatty acids are an endogenous source of reactive oxygen species, free radicals alter the process of bone turnover; however, although there are clinical evidences linking bone metabolism and dietary lipids, more clinical trials are necessary to prove whether ω-3 PUFA supplementation plays a major role in bone health.

The association between n-3 polyunsaturated fatty acid levels in erythrocytes and the risk of rheumatoid arthritis in Korean women

BACKGROUND

Rheumatoid arthritis (RA) is one of the most common autoimmune diseases that result in chronic inflammation of the joints. n-3 polyunsaturated fatty acids (PUFAs) have been suggested to play a role in the pathogenesis and clinical course of RA. The purpose of the present study was to investigate whether erythrocyte levels of n-3 PUFA are associated with an increased risk of RA and whether this could potentially serve as an indicator of RA disease activity in Korean women.

METHODS

A total of 100 female RA patients and 100 healthy women were enrolled into this study. Erythrocyte fatty acid composition and RA disease activity were evaluated in all patients.

RESULTS

Erythrocyte levels of α-linolenic acid (ALA; 18:3n3), eicosapentaenoic acid (EPA; 20:5n3), and the omega-3 index [EPA + docosahexaenoic acid (DHA)] were significantly lower in RA patients than in healthy controls. Multivariable-adjusted regression analysis showed that the levels of ALA, EPA, and the ratio of EPA to arachidonic acid were negatively associated with the risk of RA after adjusting for body weight and smoking status. Additionally, the concentration of prostaglandin E2 was significantly decreased with increased levels of erythrocyte DHA among RA patients.

CONCLUSIONS

Erythrocyte levels of EPA and ALA were negatively associated with the risk of RA in Korean women, which may be related to eicosanoid metabolism.

Polyunsaturated fatty acids and calcaneal ultrasound parameters among Inuit women from Nuuk (Greenland): a longitudinal study

BACKGROUND

The traditional diet of Inuit people comprises large amounts of fish and marine mammals that are rich in omega-3 polyunsaturated fatty acids (PUFAs). Results from in vitro studies, laboratory animal experiments and population studies suggest that omega-3 PUFA intake and a high omega-3/omega-6 ratio exert a positive effect on bone health.

OBJECTIVE

This longitudinal study was conducted to examine the relationship between omega-3 and omega-6 PUFA status and quantitative ultrasound (QUS) parameters in Greenlandic Inuit women.

METHODS

The study included 118 Inuit women from Nuuk (Greenland), aged 49-64 years, whose QUS parameters measured at baseline (year 2000), along with PUFA status and covariates, and follow-up QUS measurements 2 years later (year 2002). QUS parameters [speed of sound (SOS); broadband ultrasound attenuation (BUA)] were measured at the right calcaneus with a water-bath Lunar Achilles instrument. Omega-3 and omega-6 PUFA contents of erythrocyte membrane phospholipids were measured after transmethylation by gas chromatography coupled with a flame ionization detector. Relationships between QUS parameters and different PUFAs were studied in multiple linear regression models.

RESULTS

Increasing values of EPA, DHA and the omega-3/omega-6 PUFA ratio were associated with increased BUA values measured at follow-up (year 2002). These associations were still present in models adjusted for several confounders and covariates. We found little evidence of associations between PUFAs and SOS values.

CONCLUSION

The omega-3 PUFA intake from marine food consumption seems to have a positive effect on bone intrinsic quality and strength, as revealed by higher BUA values in this group of Greenlandic Inuit women.

The association of red blood cell n-3 and n-6 fatty acids with bone mineral density and hip fracture risk in the women's health initiative

Omega-3 (n-3) and omega-6 (n-6) polyunsaturated fatty acids (PUFA) in red blood cells (RBCs) are an objective indicator of PUFA status and may be related to hip fracture risk. The primary objective of this study was to examine RBC PUFAs as predictors of hip fracture risk in postmenopausal women. A nested case-control study (n = 400 pairs) was completed within the Women's Health Initiative (WHI) using 201 incident hip fracture cases from the Bone Mineral Density (BMD) cohort, along with 199 additional incident hip fracture cases randomly selected from the WHI Observational Study. Cases were 1:1 matched on age, race, and hormone use with non-hip fracture controls. Stored baseline RBCs were analyzed for fatty acids using gas chromatography. After removing degraded samples, 324 matched pairs were included in statistical analyses. Stratified Cox proportional hazard models were constructed according to case-control pair status; risk of fracture was estimated for tertiles of RBC PUFA. In adjusted hazard models, lower hip fracture risk was associated with higher RBC α-linolenic acid (tertile 3 [T3] hazard ratio [HR]: 0.44; 95% confidence interval [CI], 0.23-0.85; p for linear trend 0.0154), eicosapentaenoic acid (T3 HR: 0.46; 95% CI, 0.24-0.87; p for linear trend 0.0181), and total n-3 PUFAs (T3 HR: 0.55; 95% CI, 0.30-1.01; p for linear trend 0.0492). Conversely, hip fracture nearly doubled with the highest RBC n-6/n-3 ratio (T3 HR: 1.96; 95% CI, 1.03-3.70; p for linear trend 0.0399). RBC PUFAs were not associated with BMD. RBC PUFAs were indicative of dietary intake of marine n-3 PUFAs (Spearman's rho = 0.45, p < 0.0001), total n-6 PUFAs (rho = 0.17, p < 0.0001) and linoleic acid (rho = 0.09, p < 0.05). These results suggest that higher RBC α-linolenic acid, as well as eicosapentaenoic acid and total n-3 PUFAs, may predict lower hip fracture risk. Contrastingly, a higher RBC n-6/n-3 ratio may predict higher hip fracture risk in postmenopausal women.

Reduced bone breakage and increased bone strength in free range laying hens fed omega-3 polyunsaturated fatty acid supplemented diets

INTRODUCTION

The omega-3 and omega-6 polyunsaturated fatty acids (PUFAs) are the immediate precursors to a number of important mediators of immunity, inflammation and bone function, with products of omega-6 generally thought to promote inflammation and favour bone resorption. Western diets generally provide a 10 to 20-fold deficit in omega-3 PUFAs compared with omega-6, and this is thought to have contributed to the marked rise in incidence of disorders of modern human societies, such as heart disease, colitis and perhaps osteoporosis. Many of our food production animals, fed on grains rich in omega-6, are also exposed to a dietary deficit in omega-3, with perhaps similar health consequences. Bone fragility due to osteoporotic changes in laying hens is a major economic and welfare problem, with our recent estimates of breakage rates indicating up to 95% of free range hens suffer breaks during lay.

METHODS

Free range hens housed in full scale commercial systems were provided diets supplemented with omega-3 alpha linolenic acid, and the skeletal benefits were investigated by comparison to standard diets rich in omega-6.

RESULTS

There was a significant 40-60% reduction in keel bone breakage rate, and a corresponding reduction in breakage severity in the omega-3 supplemented hens. There was significantly greater bone density and bone mineral content, alongside increases in total bone and trabecular volumes. The mechanical properties of the omega-3 supplemented hens were improved, with strength, energy to break and stiffness demonstrating significant increases. Alkaline phosphatase (an osteoblast marker) and tartrate-resistant acid phosphatase (an osteoclast marker) both showed significant increases with the omega-3 diets, indicating enhanced bone turnover. This was corroborated by the significantly lower levels of the mature collagen crosslinks, hydroxylysyl pyridinoline, lysyl pyridinoline and histidinohydroxy-lysinonorleucine, with a corresponding significant shift in the mature:immature crosslink ratio.

CONCLUSIONS

The improved skeletal health in laying hens corresponds to as many as 68million fewer hens suffering keel fractures in the EU each year. The biomechanical and biochemical evidence suggests that increased bone turnover has enhanced the bone mechanical properties, and that this may suggest potential benefits for human osteoporosis.